Why we Bri­tons are so de­pressed, de­spite all those happy pills

Daily Mail - - News - DrMax@dai­ly­mail.co.uk Dr MAx THE MIND DOC­TOR NHS psy­chi­a­trist Max Pem­ber­ton may make you re­think your life

WHAT is wrong with this coun­try? I mean that quite se­ri­ously. Some­thing clearly is not right be­cause, ac­cord­ing to new statis­tics, peo­ple in the UK are among the most de­pressed in the Western world.

The data from the Or­gan­i­sa­tion for Eco­nomic Co-op­er­a­tion and de­vel­op­ment ( OECd) showed that our rates of de­pres­sion are more than dou­ble those of coun­tries such as Poland, Greece, Italy and the Slo­vak Repub­lic. And that is de­spite this coun­try hav­ing a rel­a­tively high stan­dard of liv­ing.

I think this is a fas­ci­nat­ing find­ing that tells us a lot about how so much of what we think about de­pres­sion is wrong.

Con­sider this: we have some of the high­est rates of an­tide­pres­sant pre­scrib­ing in the world — and this is ris­ing. The nHS is­sued 64.7 mil­lion pre­scrip­tions for an­tide­pres­sants last year, dou­ble the amount from a decade ago. Yet re­search also shows peo­ple are get­ting more de­pressed, not less. So what is go­ing on?

The prob­lem, I think, is that the way we un­der­stand de­pres­sion has been dom­i­nated in re­cent years by the idea that it’s just a chem­i­cal mishap in the brain; a ran­dom im­bal­ance of chem­i­cals.

This has been fu­elled by the phar­ma­ceu­ti­cal in­dus­try, which with the de­vel­op­ment of SSRIs (a group of an­tide­pres­sants, in­clud­ing Prozac, which are now the most com­monly pre­scribed) has prop­a­gated the idea that de­pres­sion can be treated with pills.

But if de­pres­sion is sim­ply a chem­i­cal mishap, then we wouldn’t be see­ing th­ese raised fig­ures. In coun­tries where pre­scrip­tion rates for an­tide­pres­sants are high, there would be low lev­els of de­pres­sion, as it would be be­ing treated — just as coun­tries with high rates of statin pre­scrip­tions see low choles­terol lev­els in the pop­u­la­tion.

If you look at it this way, given our high pre­scrip­tion rate we should have nailed de­pres­sion in the UK. But clearly we haven’t.

And that’s be­cause while brain chem­i­cals are doubt­less in­volved, clearly there are so­cial and cul­tural fac­tors, too. How­ever, with the dom­i­nance of the bi­o­log­i­cal model, this is too of­ten ig­nored.

There is no doubt that the bi­o­log­i­cal the­ory may help ex­plain what’s hap­pened to pa­tients whose de­pres­sion seems to come out of nowhere; an in­ex­pli­ca­ble black cloud which noth­ing and no one is able to shift.

It seems baf­fling and per­plex­ing be­cause they seem to have pleas­ant and sta­ble lives, yet are sud­denly in­ca­pac­i­tated for no ap­par­ent rea­son. But there are the oth­ers I treat whose de­pres­sion does seem to make sense.

I re­mem­ber be­ing asked to see a mid­dle-aged woman who’d come into A&E be­cause she was so de­pressed she’d stopped eat­ing and drink­ing.

She was a shell of a hu­man be­ing, to­tally ex­hausted and dev­as­tated by her de­pres­sion. She’d pre­vi­ously been ad­mit­ted for it and lit­tle seemed to make it bet­ter. She was so de­pressed she could hardly be both­ered to look up.

It tran­spired it was the an­niver­sary of the deaths of her hus­band and two chil­dren, caused when she had mo­men­tar­ily fallen asleep at the wheel of the fam­ily car.

Is what she was ex­pe­ri­enc­ing a prob­lem with her brain chem­istry? As I lis­tened to her story, her voice thin and dis­tant, her eyes dead and hol­low, I asked my­self what other pos­si­ble re­sponse there could be to what had hap­pened.

Wasn’t her de­pres­sion a nor­mal re­sponse to some­thing unimag­in­ably hor­ren­dous?

I’ve thought the same when I’ve worked with pa­tients with de­pres­sion who’ve sur­vived geno­cide and seen ter­ri­ble atroc­i­ties, or at the less ex­treme end of the scale, the sin­gle mum who’s liv­ing in a high­rise with scream­ing kids, try­ing to make do on a min­i­mum wage job.

Can we re­ally sum up their ill­ness as a chem­i­cal im­bal­ance that pills can cure?

THE rea­son, I think, that we as a na­tion are more de­pressed than oth­ers isn’t be­cause of a quirk in bi­ol­ogy: it’s so­cial. And a large part of it is our high ex­pec­ta­tion for our lives.

We be­lieve we should have the per­fect life and be happy all the time. This puts us un­der in­cred­i­ble pres­sure and, in striv­ing to be per­fect, we fail, mak­ing our­selves mis­er­able. Other so­ci­eties take a more prag­matic ap­proach and, iron­i­cally, as a re­sult are more re­laxed and happy.

So the an­swer isn’t to reach for the pre­scrip­tion pad, but to look at our lives and the pres­sures we put on our­selves and our chil­dren.

That is not to say that an­tide­pres­sants don’t work. Rather, it’s that we do peo­ple with de­pres­sion a dis­ser­vice if we in­sist that the bi­o­log­i­cal model of de­pres­sion is the only one that’s rel­e­vant. For it means we fail to see peo­ple holis­ti­cally or take into ac­count what has hap­pened in their lives.

When de­pres­sion is seen like this, it’s clear tablets are not al­ways the an­swer.

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